Care Home: Dussindale Park Nursing & Residential Home

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What the care home does well People are cared for by staff who are well motivated and very friendly. We observed staff welcoming visitors to the home. One person told us `the home is clean and friendly` and also that `longer serving staff are very helpful and caring`. Another person told us that ` all the staff are friendly and work extremely hard`. The home operates a good admissions process that ensures people receive the information they need at the right time in order to make an informed decision about whether to live in this home or not. The process includes a full needs assessment to ensure that people can be supported appropriately. The service follows recruitment procedures that have been based on best practice. Full checks are carried out in a timely way to help ensure that people living at the home are protected. People told us that they enjoyed the food provided at this home. They also told us they felt activities were well organised and were able to choose whether or not they wished to participate. What has improved since the last inspection? The manager has now been in post for 12 months and there was evidence that she is making good progress towards continuous improvements at his home. At the time of our last inspection, she had no deputy manager or administrator to support her but this situation has now been resolved. This inspection was able to demonstrate improvements in many areas. Medication arrangements have been improved and we saw good, safe practice. Because of this, risk of errors in medicine administration has been reduced. The manager has put in place a process to investigate all complaints and expressions of concern or dissatisfaction. We were able to see where improvements and changes in practice have occurred as a result of this approach. The facilities at the service had improved. For example, bathroom facilities now appear much less institutionalised and the home is kept clean and tidy. A process is now in place to seek the views of residents, visitors to the home and all other interested parties so that the quality of the service can be assessed. We have seen this process has started and the action plan developed as a result. What the care home could do better: There continues to be some concern around staff training and we have repeated requirements from the last inspection as a result. The service needs to ensure that more effort is made to get staff qualified in care. They currently fall well below the required 50% qualified staff and this matter needs to be addressed urgently. Staff are not receiving formal supervision on a regular and planned basis. When the supervision does take place, it is not fully recorded. The manager needs to make sure this important function is carried out in line with best practice so that staff feel supported in their role. Care plans provide very good information about the physical and health care needs of the individual. However, more work needs to be done so that people`s social, emotional and spiritual needs are considered and met. This will then ensure that person centred care is provided. Improvements have been made to the environment and the bathrooms now appear much less institutionalised. Some thought should be given to providing signs that indicate if the facilities are available or engaged so that people`s dignity is further supported. Staff need to make sure that they complete accident forms in a timely way and pass them to the manager straight away. This will mean that the circumstances of the accident can be analysed and remedial action taken if necessary. Key inspection report Care homes for older people Name: Address: Dussindale Park Nursing & Residential Home Mary Chapman Close Dussindale Norwich Norfolk NR7 0UD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Geraldine Allen     Date: 2 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Dussindale Park Nursing & Residential Home Mary Chapman Close Dussindale Norwich Norfolk NR7 0UD 01603701900 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): dussindale@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Services Ltd Name of registered manager (if applicable) Mrs Sandra Smith Type of registration: Number of places registered: care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Fifty-eight (58) Service Users may be accommodated of either sex who are aged over 65 years. From time-to-time 2 service users between the age of 50 and 65 years may be accommodated. The total number not to exceed fifty-eight (58). Date of last inspection Brief description of the care home Purpose built in 1994, Dussindale Park is situated in a modern residential suburb of Thorpe St Andrew on the outskirts of Norwich. The home can accommodate 58 older people with residential or nursing needs, in single and double rooms; 38 of the rooms have en-suite facilities and some of the ground floor rooms open up to patio areas. The accommodation is on the ground and first floor levels, and can be accessed by Care Homes for Older People Page 4 of 28 Over 65 58 0 1 1 1 1 2 0 0 8 Brief description of the care home passenger lift. The second floor is used for offices and storage. The surrounding lawns and garden areas are well maintained and can be accessed by service users. There is ample parking space at the front and to the rear of the premises. The local GP practices and other health professionals support the home. The range of fees charged at the time of inspection was between £362 to £749, depending on the level of care needed and the accommodation provided. Please refer to the manager for the current fee range. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and took place during the day of 26 October 2009. A total of 32 residents were living at the home on the day of inspection, with one resident in hospital. Before the inspection took place, the manager sent us a completed annual quality assurance assessment (AQAA) when we requested it. We also received completed surveys from two people living at the home and two staff working there. Their views are included in our findings throughout this report. On the day of inspection, we gathered information from a variety of sources. We looked at various records and documents, toured the premises, observed staff practice and spoke with residents, the manager, staff at the home and visitors to the home. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: There continues to be some concern around staff training and we have repeated requirements from the last inspection as a result. The service needs to ensure that more effort is made to get staff qualified in care. They currently fall well below the required 50 qualified staff and this matter needs to be addressed urgently. Staff are not receiving formal supervision on a regular and planned basis. When the supervision does take place, it is not fully recorded. The manager needs to make sure this important function is carried out in line with best practice so that staff feel Care Homes for Older People Page 7 of 28 supported in their role. Care plans provide very good information about the physical and health care needs of the individual. However, more work needs to be done so that peoples social, emotional and spiritual needs are considered and met. This will then ensure that person centred care is provided. Improvements have been made to the environment and the bathrooms now appear much less institutionalised. Some thought should be given to providing signs that indicate if the facilities are available or engaged so that peoples dignity is further supported. Staff need to make sure that they complete accident forms in a timely way and pass them to the manager straight away. This will mean that the circumstances of the accident can be analysed and remedial action taken if necessary. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information that helps them to make an informed choice to live at this home. Each person is given a statement of terms and conditions when they move into the home that sets out the care and facilities that will be provided and also details their rights and obligations. People have a full needs assessment completed before moving into the home to ensure the service is able to meet their needs. This home does not provide intermediate care. Evidence: The home has a statement of purpose and service user guide and these provide information to people about the service and care provided. Both documents were Care Homes for Older People Page 10 of 28 Evidence: displayed in the reception area and the administrator said they were included in information packs provided to prospective residents and their representatives either when they visit the home or when they made an initial phone enquiry. The deputy manager described the admission process. This includes a pre-admission assessment, carried out either by the manager or her deputy, to establish information about the person, their preferred activities of daily living, usual routines and likes and dislikes. This helps to establish what special equipment might be needed and also to confirm the service is able to meet the persons needs. People are also encouraged to visit the home if at all possible so that they can meet residents and staff. We spoke with people living at the home and they confirmed they had received information about the service and had also had their needs assessed before they moved into the home. This practice ensures that people are able to make an informed choice to live at this home. People told us that when they moved into the home they received further information that told them about what happens in the home on a day-to-day basis. We also saw welcome packs that had been set up in an empty room. The welcome packs included a selection of toiletries, a bath robe and information pack. People receive a contract of residence that sets out the terms and conditions of living at the home and also their rights and responsibilities. This service does not provide intermediate care. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive physical and health care support that reflects their needs. These needs are set out in an individual plan of care. More consideration needs to be given to identifying and meeting peoples social care needs and for staff to be less task orientated. Safe medication procedures are in place and staff have been well-trained about the storage, administration and recording of medicines. People are treated with respect and their privacy and dignity is supported. Evidence: We looked at 3 care plans and also spoke with 3 people living at the home, 1 visitor and 2 carers. We also received 2 completed questionnaires from people living at the home. Overall, we found the care plans were clearly written but there was a lack of information about the persons social life, their interests and hobbies. The care plans gave good guidance about daily living and how risks could be reduced aound daily activities. They were based on the pre-admission assessment and covered all matters Care Homes for Older People Page 12 of 28 Evidence: of health and personal care. The care plans also included daily notes, weekly progress notes, details of professional visits and also relative communication sheets. Basic care notes for the resident were also kept in their bedroom for staff to look at as necessary. People told us that they usually receive the care and support they need when they need it but this was not always the case. People spoke of periods when there were insufficient staff on duty, resulting in call bells not being answered very quickly. We observed staff practice and this showed that some staff are task orientated. For example, staff had provided a drink to a resident but had not returned to assist her to drink it. We also observed residents sitting in wheelchairs awaiting their turn to visit the hairdresser rather than being offered a comfortable chair to sit in. Staff told us they had little time to speak with residents during the morning because of the tasks they needed to complete. We looked at the arrangements for the storage, administration and recording of medicines and also spoke with the member of staff responsible for medicines on the day of inspection. The service uses a monitored dosage system and we found that the medicines administered were consistent with the records. The service followed good practice when dealing with controlled medicines. Other medicines such as creams and eye drops had the packaging noted with the date they were opened to ensure they were disposed of at the correct time. Those medicines requiring refrigeration were properly stored and the fridge temperatures were being recorded to ensure it was running efficiently. Medicines were dispensed from lockable trolleys kept on each floor. We had made a requirement about the administration of medicines at the last inspection and this had been met. During the course of the inspection, we observed that people were assisted with personal care behind closed doors. Staff spoke to residents in a respectful way and efforts were made to protect peoples dignity. One of the members of staff on duty told us that she was a dignity champion for the residents. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a range of activities but these do not necessarily reflect the preferences of individual residents. People are able to maintain contact with relatives, friends and the local community as they wish. People are welcomed to the home at any time. People are able to make choices around daily living and are confident staff will respect the choices they make. Meals are varied, balanced and nutritious. The service is able to meet special dietary needs. Evidence: The service employs an activities organiser, who works 4 days per week. The manager told us that the activities organiser working at the home at the time of inspection was due to leave, but a new person had been appointed and would take up their duties once a criminal records bureau check had been completed. A list of the varied activites that people could join in with was displayed on notice boards within the home. There were also outside entertainers booked on average twice per month. A Halloween party Care Homes for Older People Page 14 of 28 Evidence: had also been arranged for the end of October. The upstairs lounge had an area put aside for activities such as games, reminiscence and arts and craft. However, there were no records available for us to look at that would demonstrate people had been consulted, or that they had access to activities of interest to them. As previously stated, some staff are task orientated and this approach needs to be addressed so that residents can enjoy meaningful social interraction throughout the day. The manager told us that clergy visit once a month, however one person told us they went to the home next door in order to attend services. The visiting hairdresser was at the home on the day of inspection and residents were seen sitting in wheelchairs in a lounge and watching television whilst awaiting their turn. Visitors were seen during the course of the day and they told us they were always made welcome. People told us they were able to visit or to have visitors whenever they wished. The home has a dining room on each floor and on the day of inspection both rooms felt cold due to heating problems. The rooms were spacious and the tables attractively laid. Menus were displayed on each table and demonstrated the choices on offer for each meal. The kitchen assistant told us that he speaks to each resident every morning to find out what they would like for their meals on that day. He was able to describe the various diets that were provided by the service including soft, diabetic, reducing and vegetarian. People told us that they usually enjoy the food provided. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure that is clearly written and available to all residents and visitors to the home. Complaints and expressions of concern are taken seriously and acted upon. People are protected from abuse by well-trained staff and a robust recruitment procedure. Evidence: The service has a complaints procedure that is clearly written and is displayed in the entrance hall. The manager confirmed that residents and their representatives had also received a copy of the complaints procedure. The manager sent us information that suggested the service had received 23 complaints during the last 12 months. The manager explained to us that she records all expressions of concern and comment as a complaint regardless of whether a formal complaint has been made. She said she investigates each issue and implements changes where appropriate to improve the service. We looked at the complaints logged and records and found these were very well written and fully detailed including the action taken and when the matter was resolved. This provided us with evidence that the manager has a positive approach to complaints and concerns. Care Homes for Older People Page 16 of 28 Evidence: We looked at the staff training matrix and this showed us that 90 of staff have attended safeguarding training. We also spoke with staff who demonstrated a good understanding of safeguarding vulnerable people. We also looked at staff recruitment processes. These were robust and included written references and protection of vulnerable adults checks prior to the member of staff commencing work. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is safe and well maintained. Faults and breakdowns of equipment are dealt with quickly. There are sufficient toilets and bathing facilities but engaged and vacant signs need to be fixed to the doors. Residents own rooms suit their needs, are comfortably furnished and contain some of their own possessions as they wish. The home is clean and tidy with no unpleasant odours. Evidence: We conducted a tour of the premises and found temperature levels were variable throughout the home. We spoke with the manager about this and she stated that there had been heating problems over the course of the weekend and an engineer was expected during the day of inspection to effect repairs. The decoration of the home was in good order although we noted chipped paint in some doorways. Staff told us that residents had been involved in choosing the colour schemes for the bathrooms. Those bedrooms seen were in good decorative order. The bedrooms were personalised to varying degrees with the residents possessions and we were told people were Care Homes for Older People Page 18 of 28 Evidence: encouraged to bring items into the home. Improvements had been made to the bathrooms since the last inspection. They had been redecorated and efforts had been made to reduce the institutionalised feel with the use of pictures, hangings and other items appropriate to bathrooms. Important signs providing information to staff had been placed in frames to reduce the impact on the room. One of the assisted baths was out of order and the manager confirmed that parts were awaited. We discussed the need for signs on the bathroom and toilet doors to show if the facilities were available or engaged and the manager said she would download the relevant signs from the Internet. All the areas of the home were clean, tidy and free of odour. As previously stated, the heating levels were variable throughout the home but this matter was being dealt with. The laundry was well-equipped with two industrial washers and two industrial dryers. Both washing machines had sluicing and disinfection programs. The laundry person was spoken to briefly and she confirmed that all laundry was done on site. The whole laundry area was clean and tidy. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are generally met in a timely way, although there are times when they may need to wait for staff support. Insufficient numbers of staff have completed National Vocational Qualification Training. People are protected by the homes robust recruitment practice. staff receive statutory training and training specific to their role. Evidence: The manager provided us with a copy of the staff roster covering the week of inspection. This showed that, in addition to qualified nurses, there were seven care staff on duty on the morning of inspection and five on duty in the afternoon and evening. The home also employs catering, laundry, administrative, maintenance and activities staff. People told us there were usually staff available when they needed them although we also received comments about staff shortages from time to time. The manager said that staff absences were normally covered unless notice was too short. Staff told us that they had more opportunities to sit and speak with residents during the afternoon. Care Homes for Older People Page 20 of 28 Evidence: The manager told us that only five care staff had achieved NVQ qualifications. This means that only 18 of staff have NVQs and falls well short of the 50 trained staff required. The manager stated that she was trying to find a new provider for NVQ assessing. This matter needs to be addressed urgently to ensure that people receive care from suitably trained and qualified staff. The home follows a robust recruitment process that includes a completed application form, two written references, interview notes and checks with the criminal records bureau and protection of vulnerable adults. Applicants are also required to complete a health questionnaire. The interview checklist demonstrated is an equal opportunities approach to recruitment. A copy of the staff training matrix was provided and this showed that, apart from NVQ training, staff receive training that is appropriate to their role. This included fire safety and fire drills, food hygiene, manual handling and medicines. Other training included wound care, diabetes, pressure care, MRSA and bed rail safety. Staff were spoken with in private and confirmed the training they had received. A new member of staff spoke about her induction training and confirmed it was fully recorded. She also told us that she had not commenced working at the home until her references and criminal records bureau checks had been received. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is suitably qualified and experienced to undertake her role effectively. The views of residents and their representatives are sought and acted upon in order to ensure continuous improvement of the service. Residents are protected from financial abuse by the homes robust practice for looking after their personal allowances. Staff do not receive supervision in line with best practice. The health and safety and welfare of residents, staff and visitors to the home are protected by good practice. Evidence: The manager had been in post for approximately one year at the time of inspection. She had completed the registration process with us and had been able to demonstrate Care Homes for Older People Page 22 of 28 Evidence: competence and experience in her role. She told us she had spent time getting to know residents, staff and visitors and also an understanding of the issues at the home and the kind of action she needed to take to ensure continuous improvement of the service. We were given a copy of the summary of the last quality survey undertaken by the home. This showed that there had been a response rate of 38 to the questionnaires. Overall, the responses were positive and the summary included actions that would be taken to make improvements to the service. The manager told us that, in addition to the quality survey, she holds weekly surgeries for relatives and visitors. We saw a notice about this displayed in the entrance hall, showing dates and times when the manager was available. The service follows the companys procedures regarding residents personal allowances. The procedures were robust and the records up-to-date. The administrator described the processes followed and the checks and balances that were completed on a weekly basis. The procedures help to ensure people are protected from financial abuse. The manager told us that, whilst staff supervisions were taking place, they were not as regular as she would like. She said new procedures had been put in place and were due to commence in November 2009. At the time of inspection, the service was not meeting the staff supervisions standards. However, new procedures should ensure that staff are appropriately supported in the future. We looked at a range of health and safety records. These included fire safety, hot water temperatures, call system, window restrictors, wheelchairs and accident records. All records were up-to-date and fully recorded. However, we had concerns regarding an incident relating to a potential fire at the service that staff had not responded to appropriately. This was discussed at length with the manager and she confirmed that all staff are receiving and increase in fire safety training. She confirmed she was confident all staff had learnt from the situation and drills were being correctly completed. All fire exits were clear of obstruction on the day of inspection and fire notices were clearly displayed. In addition, all fire equipment had been checked and was appropriately located in line with fire records. We looked at the accident records and it was established that the manager was not always receiving reports in a timely way. For example, there was one accident record, dated the end of September, that she had not received until 20 October. Staff need to ensure that these reports are sent to the manager immediately so that any remedial Care Homes for Older People Page 23 of 28 Evidence: action can be taken without delay. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 27 18 The home must ensure enough skilled staff are on duty at all times To ensure residents are offered the care needs required correctly and timely. 01/01/2009 Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 28 18 Action must be taken to ensure that sufficient staff undertake NVQ training so that the 50 ratio is met. This will ensure that residents are cared for by staff who are suitably qualified. 04/01/2010 2 36 18 Staff should receive formal supervision on a regular basis that is properly recorded. This will ensure that staff are supported to undertake their role. 07/12/2009 3 37 17 Accident records must be written at the time the incident occurs and the reports passed to the manager without any delay. This will mean that an early analysis of the accident can take place and remedial action taken in a timely way. 26/11/2009 Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The care plans need to be improved so that they contain information about the persons social, emotional and spiritual needs and preferences. This will mean that staff can support people to take part in activities that are important to them. The approach of some staff towards their role is task orientated. This approach needs to be challenged so that residents can enjoy meaningful social interraction with staff throughout the day. Signage on toilet and bathroom doors should include engaged and vacant signs. This will help to enhance peoples privacy and dignity. 2 12 3 21 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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